14D2028561 CLIA NUMBER - CENTRAL ILLINOIS PREVENTIVE SERVICES L L C

Laboratory Demographics

  • CLIA Code: 14D2028561
  • Facility Name: CENTRAL ILLINOIS PREVENTIVE SERVICES L L C
  • Facility Address: 2426 W CORNERSTONE CT, STE 100
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 691-7900
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LARRY F. OVERCASH
  • NPI Number: 1306349576
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2028561
LAB Type Practitioner Other
Facility Name CENTRAL ILLINOIS PREVENTIVE SERVICES L L C
Street 2426 W CORNERSTONE CT, STE 100
City PEORIA
State IL
ZIP 61614
Phone 309 691-7900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2025
Certificate Expiration Date 8/18/2027
Facility Type Practitioner Other
Lab Director LARRY F. OVERCASH

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This page was last updated on: 9/29/2025